A Piece of My Mind |

Interpreters or Teachers?

Abraham M. Nussbaum, MD, MTS1
[+] Author Affiliations
1Denver Health, Behavioral Health, Denver, Colorado; and University of Chicago Program on Medicine and Religion, Chicago, Illinois
JAMA. 2013;310(3):265-266. doi:10.1001/jama.2013.8321.
Text Size: A A A
Published online


Like many psychiatrists, I eagerly awaited the Diagnostic and Statistical Manual, Fifth Edition (DSM-5), which corrects problems identified in earlier versions of our diagnostic manual while incorporating recent advances. The DSM-5 task force included leaders in psychiatry who worked for the better part of a decade to review evidence and revise diagnoses and diagnostic criteria. The task force made potential changes in diagnostic criteria available online, sought public comment, and revised the diagnoses again through expert review.1 Afterward, they conducted field trials at academic medical centers to assess reliability. Despite all of this learned effort, the interrater reliability of one of the most common mental disorders, major depressive disorder, remains discouragingly low, with a κ of 0.28 in both adults and children indicating only “questionable agreement” between two mental health clinicians evaluating the same person for depression.2 Because most diagnoses of major depressive disorder occur in community settings, where the criteria are presumably applied less rigorously, what are we saying when we diagnose a person with major depressive disorder? More broadly, what does this say about what goes on when we physicians directly examine a patient?


Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
First page PDF preview




Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

Related Topics